Blepharitis

What is Blepharitis?

Blepharitis is a chronic inflammation of the lid margins (the edges of the eyelids), typically affecting both eyes. It is a common, often recurrent condition that can significantly impact quality of life through persistent irritation. Although benign, it requires consistent management to prevent flare-ups.

Common Symptoms

• Redness and swelling of the eyelid edges.‍
• Gritty sensation, burning, or the feeling of a foreign body in the eye.‍
• Itching (Pruritus).‍
• Crusting or flakes at the base of the lashes (particularly upon waking).‍
• Watery eyes or conversely, Dry Eye symptoms.‍
• Fluctuating vision.‍
• Eyelash abnormalities (loss or misdirected growth in chronic cases).

Main Causes

Blepharitis is often multifactorial and is generally classified into two types:

1. Anterior Blepharitis (affecting the base of the lashes):
   • Bacterial: Usually caused by Staphylococcal bacteria.
   • Seborrhoeic: Associated with oily skin or dandruff.
   • Parasitic: Caused by Demodex, a microscopic mite.
2. Posterior Blepharitis (Meibomian Gland Dysfunction - MGD):
   • Clogged or inflamed oil glands (Meibomian glands), which reduce tear quality.
   • Frequently associated with Ocular Rosacea.

The two forms often coexist, known as mixed blepharitis.

Possible Complications

• Dry Eye Syndrome: Due to an unstable tear film.
• Chalazia or Styes: Repeated blockages or infections of the eyelid glands.‍
• Marginal Keratitis: Secondary inflammation of the cornea.‍
• Contact Lens Intolerance.

Management and Treatment

1. Essential Eyelid Hygiene (The Foundation of Care)

A consistent routine is the most effective way to manage blepharitis:

• Warm Compresses: Apply a clean, warm flannel or a reusable warming eye mask to closed eyelids for 1–2 minutes. This liquefies the oils and opens the Meibomian glands.
• Eyelid Massage: Gently massage the lid margins with clean fingers or a cotton bud:
  • Upper lid: Massage downwards toward the lashes.
  • Lower lid: Massage upwards toward the lashes.
  • This helps express the glands and clear blocked secretions.
• Eyelid Cleaning: Use a dedicated eyelid wipe or a cotton pad soaked in a specialized lid cleansing solution (or saline) to delicately rub the base of the lashes. This removes debris, crusts, and bacteria.‍
• Frequency: Perform this 1–2 times daily during active phases. Once symptoms improve, this can be reduced to a maintenance routine a few times a week.

2. Complementary Clinical Treatments

If hygiene measures alone are insufficient, your ophthalmologist may prescribe:

• Lubricating Eye Drops: To manage associated dryness.‍
• Antibiotics: Topical ointments or oral medications (e.g., Doxycycline) for severe cases.‍
• Demodex Treatment: Specifically formulated Tea Tree Oil cleansers.‍
• Anti-inflammatories: Short-term topical steroids or long-term Ciclosporin/Tacrolimus drops to reduce chronic inflammation.‍
• IPL (Intense Pulsed Light): Advanced therapy for certain chronic forms of blepharitis and MGD.

To remember

• Blepharitis is chronic but manageable.
• Daily eyelid hygiene is the key to success.
• Treatment is often personalized depending on the type of blepharitis and patient's tolerance.
• An ophthalmological consultation makes it possible to confirm the diagnosis, identify the cause (sometimes Demodex or rosacea) and adapt treatment.